Psychotic symptoms in the context of levodopa treatment in Parkinson’s Disease: clinical feature or iatrogenesis?
Introduction We present the case of a 65-year-old woman who was prescribed levodopa by the Neurology department due to motor symptoms that were not clearly suggestive of a diagnosis of Parkinson’s Disease (PD). Before that, the patient had never showed any hallucinations or delusions. After years o...
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| Format: | Article |
| Language: | English |
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Cambridge University Press
2022-06-01
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| Series: | European Psychiatry |
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| Online Access: | https://www.cambridge.org/core/product/identifier/S0924933822017655/type/journal_article |
| _version_ | 1797616399338700800 |
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| author | M.L. Costa A. Cerame |
| author_facet | M.L. Costa A. Cerame |
| author_sort | M.L. Costa |
| collection | DOAJ |
| description |
Introduction
We present the case of a 65-year-old woman who was prescribed levodopa by the Neurology department due to motor symptoms that were not clearly suggestive of a diagnosis of Parkinson’s Disease (PD). Before that, the patient had never showed any hallucinations or delusions. After years of increasing doses of levodopa, the diagnosis of PD was withdrawn. However, during the treatment the patient developed severe psychosis with severe impairment of social functioning. Levodopa is the most effective treatment for motor symptoms in PD. However, it might involve difficulties in dose-control and may present with deletereous complications and adverse effects.
Objectives
To analyse the incidence of pharmacological psychotic symptoms after levodopa treatment.
Methods
A case report is presented alongside a review of the available literature regarding psychotic symptoms in patients treated with levodopa.
Results
Hallucinations and delusions are prevalent symptoms of PD. Nonetheless, they could also be potential side-effects of levodopa treatment. When psychotic symptoms occur, they are commonly attributed to the natural course of the disease. Available evidence does not provide with clear guidelines to distinguish the iatrogenic syndrome from the one caused by the disease itself. Our patient, whose PD diagnosis was dismissed, presented extreme psychotic symptoms which disappeared after the discontinuation of levodopa treatment.
Conclusions
Levodopa is an effective treatment with important risks which must not be overlooked. Adverse effects of the drug could have been minimized by making an accurate differential diagnosis of PD. Individualized benefit-risk balance previous to prescription and a close follow-up should be standardized.
Disclosure
No significant relationships.
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| first_indexed | 2024-03-11T07:40:24Z |
| format | Article |
| id | doaj.art-bcc12e9f476d4dd5854dfac36b2e809b |
| institution | Directory Open Access Journal |
| issn | 0924-9338 1778-3585 |
| language | English |
| last_indexed | 2024-03-11T07:40:24Z |
| publishDate | 2022-06-01 |
| publisher | Cambridge University Press |
| record_format | Article |
| series | European Psychiatry |
| spelling | doaj.art-bcc12e9f476d4dd5854dfac36b2e809b2023-11-17T05:08:45ZengCambridge University PressEuropean Psychiatry0924-93381778-35852022-06-0165S686S68610.1192/j.eurpsy.2022.1765Psychotic symptoms in the context of levodopa treatment in Parkinson’s Disease: clinical feature or iatrogenesis?M.L. Costa0A. Cerame1Hospital Universitario Severo Ochoa, Psychiatry, Leganes, SpainHospital Universitario José Germain, Hospital De Día, Leganes, Spain Introduction We present the case of a 65-year-old woman who was prescribed levodopa by the Neurology department due to motor symptoms that were not clearly suggestive of a diagnosis of Parkinson’s Disease (PD). Before that, the patient had never showed any hallucinations or delusions. After years of increasing doses of levodopa, the diagnosis of PD was withdrawn. However, during the treatment the patient developed severe psychosis with severe impairment of social functioning. Levodopa is the most effective treatment for motor symptoms in PD. However, it might involve difficulties in dose-control and may present with deletereous complications and adverse effects. Objectives To analyse the incidence of pharmacological psychotic symptoms after levodopa treatment. Methods A case report is presented alongside a review of the available literature regarding psychotic symptoms in patients treated with levodopa. Results Hallucinations and delusions are prevalent symptoms of PD. Nonetheless, they could also be potential side-effects of levodopa treatment. When psychotic symptoms occur, they are commonly attributed to the natural course of the disease. Available evidence does not provide with clear guidelines to distinguish the iatrogenic syndrome from the one caused by the disease itself. Our patient, whose PD diagnosis was dismissed, presented extreme psychotic symptoms which disappeared after the discontinuation of levodopa treatment. Conclusions Levodopa is an effective treatment with important risks which must not be overlooked. Adverse effects of the drug could have been minimized by making an accurate differential diagnosis of PD. Individualized benefit-risk balance previous to prescription and a close follow-up should be standardized. Disclosure No significant relationships. https://www.cambridge.org/core/product/identifier/S0924933822017655/type/journal_articleParkinson diseasePSYCHOTIC DISORDERSpsychopharmacologypsychostimulants |
| spellingShingle | M.L. Costa A. Cerame Psychotic symptoms in the context of levodopa treatment in Parkinson’s Disease: clinical feature or iatrogenesis? European Psychiatry Parkinson disease PSYCHOTIC DISORDERS psychopharmacology psychostimulants |
| title | Psychotic symptoms in the context of levodopa treatment in Parkinson’s Disease: clinical feature or iatrogenesis? |
| title_full | Psychotic symptoms in the context of levodopa treatment in Parkinson’s Disease: clinical feature or iatrogenesis? |
| title_fullStr | Psychotic symptoms in the context of levodopa treatment in Parkinson’s Disease: clinical feature or iatrogenesis? |
| title_full_unstemmed | Psychotic symptoms in the context of levodopa treatment in Parkinson’s Disease: clinical feature or iatrogenesis? |
| title_short | Psychotic symptoms in the context of levodopa treatment in Parkinson’s Disease: clinical feature or iatrogenesis? |
| title_sort | psychotic symptoms in the context of levodopa treatment in parkinson s disease clinical feature or iatrogenesis |
| topic | Parkinson disease PSYCHOTIC DISORDERS psychopharmacology psychostimulants |
| url | https://www.cambridge.org/core/product/identifier/S0924933822017655/type/journal_article |
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